Provider Demographics
NPI:1225055007
Name:THRIFTY PHARMACY NO III INC
Entity Type:Organization
Organization Name:THRIFTY PHARMACY NO III INC
Other - Org Name:THRIFTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-751-2852
Mailing Address - Street 1:10904 N MAY AVE STE L
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6203
Mailing Address - Country:US
Mailing Address - Phone:405-751-2852
Mailing Address - Fax:405-755-2952
Practice Address - Street 1:10904 N MAY AVE STE L
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6203
Practice Address - Country:US
Practice Address - Phone:405-751-2852
Practice Address - Fax:405-755-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336L0003X
OK147013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100238220AMedicaid
2073580OtherPK
OK100238220AMedicaid